medical x-ray visits and examinations during pregnancy

NATIONAL CENTER Series 22 For HEALTH STATISTICS INumber:6

VIXAL and HEALTH STATISTICS

DATA FROM THE NATIONAL VITAL STATISTICS SW3TEM

Medical X-ray Visits and Examinations During Pregnancy

United States 1963 PRWPRWFWE‘ PL.W.!CATKIK5W3ANCI-?iiww” MHARY

Statistics on the number of medical X-ray visits and examinations

during pregnancY for women having a live birth, by selected demo-graphic characteristics of the women by trimester, previous preg

nancy experience and type of examination, and by type of facility.

Based on data collected in a survey of physicians and hospitals

providing care to a sample of women having a’ live birth in 1963.

Washington, DC. June 1968

U.S. DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE Public Health Service

Wilbur -f. Cohen Wil Iiam H. Stewart

Secretary Surgeon General

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Public Health Service Publication No. 1000%eries 22-No. 5

For sale by the Superintendent of Doouments, U.S. Government Prin~mg Office WasMngton, D. C., ‘20402 - Pries 40 cents

,,NATIONAL CENTER FOR HEALTH STATISTICS ....4.,

THEODORE D.WOOLSEY,Director

PHILIP S. LAWRENCE, SC.D., Associate Director

OSWALD K. SAGEN, PH. D.,, Assistant Director for Health Statistics Development

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development

ALICE M. WATERHOUSE, M. D., Medical Corzsul&zt ‘“ ‘

JAMES E. KELLY, D. D. S., Denttil Advisor

LOUIS R. STOLCIS, M. A., Executive Officer

MARGERY R. CUNNINGHAM, Information O//icer

,.

DIVISION OF VITAL STATISTICS ,. .,

ROBERT D. GROVE, Ph. D., Director ‘

ROBERT A. ISRAEL, M. S., Deputy Director

ARTHUR A. CAMPBELL, special ,Assistant to tke Director

‘ROBERT A. ISRAEL, M. S., Acting Chief, Mortality ‘Stati~tics Branch

PATIENCE LAURIAT, M. A., “Acting chief, Natality .Statistics Branch

ROBERT D. GROVE, ph. D., Acting Chic/, Registration MetAods Branch

PATIENCE LAURIAT, M. A., Chief, Marriage and Diuorce Statistics Branch

ARNE B. NELSON, M. A., chief, vital Records Survey Branch

ALICE M. HE TZEL, chief, Statistical Resources Sectian ,“

Public Health Service Publication No. 1000-Series 22-5

Library of Congress Catalog Card Nurn ber 68-60059

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,. CQNTENTS . . , ..~~ .,, ,, ,. . .

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Introduction -----T----y .“ . . .

,. Selected F,&@gs------------------~---7,--------.-~---------------~TT--

Sources and Limitations of Data--~---------------=--------------------

,, Mothers Witi Medical X-Ray Visits---------"-----------------------------.,,.

,, ., ,,.,_ ,-: ._. X-Rqy Visits and Ex~tiations-~----7-v------T---------------------------

Color and Age ofMother---------~--~---------~---------,------:-r---Geographic Region mdMetropolitm Status-------:-~----------:---=---Color and Family hcome-------v--u----------U-,-----,-----------------

T~eof Ex&tiation----------------~-----------------------T----Y-----'Type of Facility by T~eof ExamtiationTrtiesterv of Emmtiation-----------J----------------~--------------,Color and Age of Mother---------~------------------------J---------Previous Pregnancy Experience------=-----------------------:-------Color and Family hcome

.,, . ,.

Page

Comparison With Rates for Women in General Population,. .

References --------------------------------~---------------------=---,,, ..,.

Detailed Tables

Appendix 1. Tectiicd Notes on MefiodsStatistical Desi@of National Natality Survey --------------------------Reliability of Esttiates

Appen& II. Definitions of Certain Terms Used in This,ReportT

Appendix III. Source FormsStandard Certificate of Live Btith--=---------------------------------Survey Questiomaire for Mothers-----------;-------------,-----------Survey of Medical and'Dental Cme----------------------------------- ,Survey Questionnaire for Physicians

Survey of Radiological Exatiat~onsSurvey Questiomatie for Medical Facilities---,

Survey of Radiological ExamMations

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3 3 4 5

5 5 6 7 8

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23 23 24

28

30 30 31 32 34 35 38 39

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IN THIS REPORT statistics ave pvesented on the num.bev of medical X-ray visits and examinations duving @egnancy of wornen who h@ a live birth during 1963. Differences in the volume of medical X-vay cave are shown by such dem.og7aphic characteristics as CO1OY,age, income, geographic vegion, and vesidence in metropolitan ov n.onmetvopolitun aveas. Othev vaPtab@ incl@e 7@@of medical facz~ity, type of exami. . nation, tvim%iti of examination, and pkeviou3 ‘j#egnancy expedience. The.data ave, based on,.a probability sample of, 4,096 live.,;. bivths OCCUY-,

..’ %&.ik ‘1963. ‘., 5 :“’‘

About 900,000, OY 23 pwcent, of the women gz”ving birth in 1963 had 1,085,000 medical X-ray visits dum”ngpregnancy. A higher pvopovtion of nonwhite ,pothers than white had ,medical X-ray visits. Nonwhite females rnaEi@ visits showed greater” va?c?’abili~yby age tl& white females. The visit vate was 27 visits pev 100 pregnant women. Both visit rates and examination vates weve highev fov nonwhite females in each age group than fov white. The greatest difference in visit rates was fov mothers aged 25-29 years, and in examination rates it was for mothezs aged 25-29 and 30-34 years. Mothers in the West Re@”onhad the highest visit and examination vates; those in the South and Novtheast had the lowest. Mothers in metropolitan areas had highti visit and examination vates than those in nonmetvopolitan aveas. Both rates were faivly unifom in metropolitan areas by ve~”on, and quite variuble in rwnmetro-’ ‘politan aveas.

Almost 84 percent of the examinations veported duving pregnancy we?% pevfovmed in such facilities as hospitals and clinics. ,The variation in type of’ facility accovding to type of examination shows that about one- ,.

fourth of the examinations of the utems and pelvic ve~”on weve peYfovmed in ph~sicians’ offices: one-thivd of these ware pevfqfied ??Y general fivactitionezs and one-thivd by obstetricians and gynecolop”sts. ,, A b?<yu.-o?@hj,Yd of the examinations d~ri~l the, .@st trimeste-r wev~ f~v . . .~..— X-YcIy, pelvimefry-%-~24 ”>~~&%~-w–&e-.~#arni@-tio-ns-‘of”the abdomen,

. . wh$ch w&e related to pvegnuncy. Exam’%ations tiuving,the fivst and’”kee,-’ . . ... .. .>+.7

ond tvimes ten were pvedo.minuntly of the chest. Rates fov chest exami-nations were higher for nonwhite females than fov white; those for ex.-arninations of the abdomen weve about thq same for white ati ~nw~ite females, and fov pelvimetvy they were somewhat highev for white. The ,vate fov pelvimetvy was highev for pvimipavous, thun for multipavoqs women. Rates $or othev examinations of the abdomen ware somewhat highev at highev pavities. At each parity the medical X-ray exarninaiion rate was significantly higher for women who had had a priov fetal loss. Most of the differences here velate to examinations of the abdomen..,

X-vay examination rates generally do not appear to be related to income.

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I SYMBOLS

Data not available Category not applicable Quantity zero Quantity more than O but less than 0.05 -----Figure does not meet standards of

reliability or precision

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.- ME616AL X-RAY VISITS “ AND EXAMINATIONS I)(JRING PREGNANCY

Morton L. prown, National Center fw” Radiological Health,

Arne B. Nelson, National Center for Health Stu;istics

INTRODUCTION

The importance of X-rays as a major source of radiation exposure has been recognized in recent years. The need to obtain reliable data on the extent of medical X-ray exposure to various segments of the population underlies the development of programs to promote the most efficient use of the X-ray. One segment of the population for which information is of particular significance is ‘that represented by pregnant women, since exposure to this group may have

- implications mot OI@ for the woman herself but also for the developing fetus.

This report provides estimates of the extent of medical X-ray visits and examinations during pregnancy of women who had a live birth during 1963. It is based on data collected in the National Natality Survey for a probability sample of 4,096 women. Information about medical” X-ray care received by these women was obtained from phy-’ sicians, hospitals, clinics, and other institutions which provided the care. The data derived from this survey provide national estimates riot previously available.

In this report data are presented describing the volume of’ medical X-ray care received by women during pregnancy in terms of the amount of such care and its relationship to selected characteristics. . .

SELECTED FINDINGS

About 23 percent of all women having liveborn infants during 1963 had one medical X-ray visit.

or more during pregnancy, with the proportion of nonwhite mothers (26 percent) being higher than that of white (22 percent). The rate for medical ‘ X-ray visits was more variable by age for non-white mothers than for white: this rate was some-what higher for, nonwhite mothers mder 20 years of age and 25-29 years than for white.

The rate of medical” X-ray visits for all mothers was 27 visits 4per 100 pregnant women.’ ‘This rate was higher for nonwhite’ mothers than for white in each age group. For both white and nonwhite mothers the rate was fairly uniform for each age group except for-the comparatively low ,..

rate for white mothers aged 25-29 years: The visit rate for nonwhite mothers was 58 percent above that for white mothers in this age group.’ For white and npnwhite mothers the examination rate was slightly above the visit rate at all ages except 25-29 and 30-34, where there was a substantially higher examination rate among nonwhite mothers.

Many of the mothers who made medical X-ray visits during pregnancy had more than one visit. When visit and examination rates are based on these mothers, the rates reached a peak for white mothers at ages 25-29 and a low point at ages 30-34. In ‘contrast, rates were relatively high for nonwhite mothers aged 30-34 and relatively

. low for those 25-29. . -Mothers in the West Region had the highest

visit and examination rates; those in the South and N~rtheast had the lowest. Mothers in metropolitan areas had higher visit and examination rates than those, in nonmetropolitan areas. The

“visit. and examination rates by region in metro-

1. ..<

politan areas were fairly uniform; those @ non-metropolitan areas were quite variable—visit rates ranged from a low of 17 per 100 mothers in the Northeast Region to 27 per 100 mothers in the West.

Visit and examination rat~s show little relationship to family income. Hp&ti@, hijgher ‘:~. rates were shown for nonwhite mothers than for white “IN‘fa@ili@ with,’ [email protected] of; $2_Jl~0’.‘“

$3 ,999”’atid $4:000:$6:%<. “’ : . ., ,, Almost 84 percent of the medical X-ray

examinations during pregnancy, were per for.rned. , in places other than physicians 1 private offices.

cantly higher for women who had one fetal loss or more prior to the present pregnancy. Most of the difference in examination rates were for examinations of the abdomen.

Examination rates’ for X-ray pelvimetry and other examinations of the abdomen did not appear to be, s~gnificaqtly: ~e~ated to income. However, the rate for chest examinations, particularly for wliitej mother’s,; ,a~peaye,dto,declin’~ wifh;n.cre,asing../, .,income; ‘“ ‘“ -

SOURCES AND

Of ‘the remaining 16 percent, ‘one-fourth ‘were ‘“”‘ : WiiITATIONS OF DATA performed by general practitioners, one-third by obstetricians or gynec~logists, and the balance by. other specialists, including ,radiologists. Almost one-fourth of the examinations of the uterus and.. pelvic region ~ere, performed in physicians’ offices. Of these, approximately one-thir~ were done. by general practitioners and one-third by obstetricians and gynecologists..

More than one-half of the medical. X-ray examin@iqns- during pregnancy ,were done during the @jrd, ‘trimester, Approximately one-third .,of me ,examinations during the third trimester were fqr, X-ray. pelvimetry aqd, one-fourth were for other exap-@@ions of the abdomea related to pregnapcy. During the, firstand second trimesters a Iarg.e proportion of the examinations wqre of the chest. Virtually all X-ray pelvimetry was done during, the last trimester as were over, nine-tenths of :the other abdominal examinations related to pregnancy.. ,.

: Nonwhite women had higher rates for chest examinations than did white women. Rates for examinations of the abdomen were about the same for while women as for nonwhite; however, the rate of ~-r.ay pelvimetry for white mothers was higher than, that for nonwhite. The rate of women having, X-ray, pelvimetry ,duriyg+ pregnancy, appeared generally to decline with increasing age, while the rate for other examinations related to pregnancy generally increased with age.

The rate of X-ray pelvimetry was significantly higher among primi.parous women than among multiparous women. Correspondingly, othe,r examinations of the abdomen had somewhat higher rates at high parities. At each parity the medical examination rate appeared to be signifi -

Statistics presented,iq th~s”-report are based on information obtained in a mail survey of mothers. and physicians,. hospitals,, orother, medical facilities identified in a representative sample, of live births occurring during. 1963. me s~mple of., 4,096 live. births. was selected, fqoW among the more than, 4 ,million events that occurred t~:at year. Birth .recoyds weze jselected independen~ly, from within, ,the file for each State and other in-j detpeqdent, ~egistration ,areas at a rate “of one, record per l, OOO:liye.,births- , , “‘ -,.,,

Data $or the, survey “were obtained, @orn five sources: the bimh re,cord” itself, the mother ~a?, identified on the birth yecord,, physicians, d,entists,. and hospitals or other medical facilities providing. care “to, the mother, during the, Year prior, to the birth. The birth record provided data on color, land age of mother, mother’s plqce of residence, and, live-birth o,~der of the, $hild. as,, well as the name of’ the attending physician and.. hospital (if ,any). The mother ,was questioned abut selected socioeconomic characteristics and,. was, asked to identify the physicians, ”dentists? and medical facilities. which bad provld~d her, care. The sources named by the .rn,other, thqse named on the birth certificate,, and any additional sources named by these primary sources. were questioned by mail ,concerning possible medical X-ray examination, or ~treatment of the rnotper. Their responses represent the sole source of X-ray ,information, since the mother was not directly asked abow her medical X-ray visits and examinations.’ Mothers of illegitimate children were not as,ke,d, for information, However, medical sources identified on the birth record

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were questioned about possible X-ray care given the mother, and referrals from their sources were also questioned.

Although the survey design included all uses of medical X-ray for diagnosis or therapy, it should be noted that all of the data reported in the survey related to diagnostic uses rather than to X-ray therapy. Facsimiles .of the questionnaires sent to hospitals,’ physicians, dentists, and informants appear in Appendix III. A description of methods and procedures followed in the survey may be found in Appendix I along with a description of the estimation procedures. Terms used in this report are defined in Appendix II.

The data in this report are based on a sample and are therefore subject to sampling error. Tables of approximate sampling errors and instructions for their use are prwented in Appendix I. Sources of error associated with nonresponse, with possible misunderstanding of questions in the survey, and with processing and compilation of data affect the quality of the data presented in this report and may create bias in the statistics. Nonsampling errors and some measures relating to bias in the survey are also discussed in Appendix I.

MOTHERS WITH MEDICAL

X-RAY VISITS

Over 900,000 mothers had one medical X-ray visit or more during pregnancy in 1963 (tabie 1). A higher proportion of nonwhite mothers than of white had medical X-ray visits during pregnancy (26 percent and 22 percent, respectively).

The proportion of mothers at different ages who had medical X-ray visits is shown in figure 1. The data for white mothers show little variation by age, except for a comparatively low proportion having X-ray visits at ages 25-29 years (17 per-cent). Among nonwhite mothers there was greater variability by age. The experience of nonwhite’ mothers was about the same as that of white mothers at ages 20-24 and 30-34; at ages under 20 and 25-29, however, nonwhite mothers had a considerably higher proportion of X-ray visits than did white mothers. A lower percent of non-white mothers than of white had medical X-ray visits at ages 35 and above.

301

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Figure “l.” Percent of mothers wi’th One’-.med ical X-ray, visit or ,more during pregn”~ncy,!Iiy“age ofmother and colo’r. ‘. .S “:‘

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X-RAY VISITS AND EXAMINATJO.NS

A substantial proportion of mothers who had medicaI X-ray visits durkg pregnancy made more than one such visit. The total number o~ X-ray visits was 1,085,000, representing about 1.2 visits per woman having me@cal, X-ray visits. The overall visit rate was 27 visits per 100 pregnant women (table 2). , ~~

... .Color and Age of Mother

. . .. The rate of. visits for white rno~ers ~was.

about 22 percent below that for nonwhite mothers. Except for a comparatively low rate of. 21 visits per 100 pregnancies for mothers 25-29 .year,s of age, the visit rate for white mothers was fairly uniform at 26 to ,28 visits per 100 pregnancies (fig. 2). For nonwhite mothers .fie visit rat~,, showed even. greater uniformity, varying: from 31 to 35 visits per 100 mothers. The greatest. difference in visit rates for white and nonwl@e

.,

3.

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U White

@jjNwwbite 34,8

Under 20 20.24 25-29 30-34 35 years yeore yeors years years md over

AGE OF MOTHER

Figure 2. Rate per 100 mothers of medical X-ray::;::: during pregnancy, by age of mother and

mothers was in the age group 25-29 years,where the rate for nonwhite mothers was 58 percent above that for white.

The examination rates for all mothers were slightly above the visit rates for all mothers in each age group. This was also true of the examination and visit rates by age for white females. Among nonwhite females, the examination rate was substantially higher than the visit rate at ages 25-29 and 30-34.

Visit rates which are based on all mothers do not adequately measure the impact of the relatively small numbers of mothers who had more than one X-ray visit. For this reason, rates per 100 mothers with one medical X-ray visit or more were also calculated and are shown in table 2. A comparison of these rates

by age shows some differences from the rates based on all mothers in the survey. In particular, white females had a higher visit rate at ages 25-29; nonwhite females showed a greater variability in rates, with low rates for ages under 20 and for 25-29 years. Examination rates by age present somewhat the same picture as visit rates. In addition the examination rates for white females were substantially higher than the visit rates except for age groups 20-24 and 30-34 years. For nonwhite females they were substantially higher for ages 25-29 and 30-34.

Geographic Region and Metropolitan Status

Mothers in the West Region had the highest visit rate, and those in the South and Northeast had the lowest (table 3 and fig. 3). The examination rates followed about the same pattern as the visit rates. The visit rate for mothers with one X-ray visit or more differed from the visit rates for all mothers in that both the South and West Regions had high rates. The examination rates for mothers with one X-ray visit or more were highest in the South Region and lowest in the North Central.

Mothers in metropolitan areas had higher visit rates and examination rates than those in nonmetropolitan areas. This was true for each region. In regional comparisons both visit and examination rates were fairly uniform for metro

“@itan areas but quite variable for nonmetropolitan areas. The visit rates for nonmetropolitan areas varied from a low of 17 visits per 100 mothers for the Northeast to a high of 27 visits per 100 mothers for the West. The examination rates followed about the same pattern.

When the rates are based on the number of mothers with one X-ray visit or more, there is greater variability in both visit and examination rates and a changing relationship between metropolitan and nonmetropolitan areas. Both visit rates and examination rates for metropolitan areas were highest in the South and lowest in the North Central. In nonmetropolitan areas the visit rate was highest for the West and lowest for the Northeast. The examination rates for nonmetropolitan areas were lower than those for metropolitan areas in each region except the West, where the rate for nonmetropolitan areas was higher than that for metropolitan areas.

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-Metropolitan “ ,

@ Nonme?ropliton

Allregions NortheastNorth Centml South West

GEOGRAPHICREGIONS

visits during pregnancy, by geographic region W! residence in metropolitan and nonmetropolitan areas.

Color and Family Income

Visit and examination rates do not show much relationship to family income for either white or nonwhite mothers (table4 and fig. 4). Rates were lower for nonwhite mothers in families within-come less than $2,000 than for those with income levels of $2,000-$3,999 and $4,000-$6,999. Hoyever, the same was not true for white mothers. Comparison of white and nonwhite mothers by income levels showed higher rates among non-white mothersin families withincomes of$2,000-$3,999 and $4,000-$6,999 than among white mothers in these same income groups. This difference may reflect relatively greater use by nonwhite women of medical care provided by public clinics and hospitals.

The rates for visits and for examinations for mothers with one X-ray visit or more showed abok the same relationship to income as that shown above. Also, a comparison of rates for white and nonwhite mothers with one visit or more showed about the same relationship to income as did the rates for all mothers.

TYPE OF EXAMINATION

Type of Facility by Type of Examination

Almost 84 percent of the examinations re-ported during pregnancy were not performed in physicians’ private offices (tables 5 and A). Of the 16 percent done, in physicians’ offices, about one-fourth were performed by general practitioners,

40 _ Under $2,000

EZZ4 $2,000-$3,999

~ $4,000-$6,999

m $7,000 and over

= Not .scert.i.ed r

30

w K g

,:-. . I o z o .. 0 20 -

E u n w i-a a

10-

0-White Nonwhite

COLOR

Figure 4. Rate per 100 mothers of medical X-ray .-& visits during pregnancy, by color and fa!mily income.

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Table A. Percent distribution of X-ray examinations during pregnancy cility according to type of examination: United States, I. \

Type of examination All facilities

Total

Examination of the abdomen: Pelvi.metry Other related to pregnancy Lower abdomen not related to

pregnancy Upper abdomen not related to

pregnancy

Examination of: Chest -. Extremities Head and neck

100.0

100.0 100.0

100.0

100.0

100.0 100.0 100.0

almost one-third by obstetricians andgynecolo@sts, and the balance by other specialists,, jm-. cludhiig r~diologi-sms. . .~e, .WW”faiion’<n ““type of facility according to type-of examination shows that almost one-fourth of the examinations of the uterus and pelvic region were performed inphysicians’ offices; approximately one-third ofthese were done by general practitioners and one-third by obstetricians and gynecologists. Only 12 per-cent of the radiographic chest examinations and only 10 percent of photofluorographic chest films (mass miniature screening films)wereperformed in physicians’ offices.

Trimester of Examination

Approximately one-third of the examinations done during the last trimesterof pregnancy were for X-ray pelvimetry ,while an additional 24per-cent were other examinations of the abdomen related to pregnancy (tables 6 and B). Less than

“v’Type of facility /

Physician’s office

. . L other

Other places

=

Percent distribution

16.3 4.3 5.2 6.8 83.7

21.6 7.7 6.2 7.7 78.4 23.5 7.6 7.6 8.3 76.5

15.2 9.1 6.1 84.8

16.7 16.7 83.3

12.2 2.9 4.2 87.8 22.9 2.9 2.9 12: 77.1 26.3 26.3 73.7

40 percent of the examinations during the last trlm=t=i”-+’~~e ‘of-the chest;-hovwer, !he first and second trimesters were more heavily weighted by such examinations. Chest examina~ “ tions amounted to77 percent of the examinations during the first trimester, and over 85 percent of those during the second trimester (table B).

Virtually all X-ray pelvimetry was done during the last trimester, as were over 90per-cent of the other abdominal examinations related to pregnancy (table C). Over halfof theabdominal e& minations not related to pregnancy were done during the first trimester; about one-fourth were done during the third trimester. Most of the photofluorographic (mass miniature screening) examinations were done during the third trimester, many on admission for delivery. However, other chest examinations (primarily radiographic) were more evenly distributed over the three trimesters.

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Table B. Percent distribution of X-ray examinations during pregnancy, by type of examination according to trimester of examination: United States, 1963

Abdomen Chest

Total I All medical Other Other I I other

Trimester exami- examinations Pel- related not

to related Photo- Other nationsfluoro- Chesttovimetry preg-

preg- graphicnancy

nancy

Percent distrifmtian

Total------------- 100.0 18.7 14.1 G*2 7*5 50.4 5.1

First trimester 100.0 0.4 1.4 11.5 6.5 70.6Second trf.mester 100.0 2.8 8.6 77.3 :::Third trimester 100.O 3::? 2::: 2.1 7.4 30.2 2.5

may reflectahigherColor and A,ge of Mother thatthisdifference incidence of tuberculosisand otherchestdiseasesamong

Number of examinationsand ratesper 100 nonwhitewomen. Rates for examinationsof the -—women by typeof examinationand by colorand abdomen appearnottovarysignificantlybetweenage of mother are presentedin tables7 and8. thetwogroups.Thereissome evidence,however,The overallrates for nonwhitemothers were thatthe rateof X-ray pelvimetryis somewhatsignificantlyhigherthanthoseforwhitemothers higherforwhitewomen thanfornonwhite.at every age. However, thisdifferentialwas The rateofwomen havingX-ray pelvimetrylargelyaccountedforby thehigherratesofchest duringpregnancy appears to declinegenerallyexaminationsfornonwhitewomen. Itimprobable withincreasingage (tableD).This is undoubt-

Table C. Percent distribution of X-ray examinations during pregnancy, by trimester ofexamination according to type of examination: United States, 1963.

Chest

I Total Other Allmedics1 Other othernotTrimester exami- Pel- related related Photo- examinations to fluoro- Other nationsvimetry to chest

Total

First trimesterSecond trimesterThird trimester

preg- preg- graphicnancy nancy


II I I mII

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Table D. Percent distribution of X-ray examinations during pregnancy,by age of motheraccording to type of examination:United States, 1963

Abdomen Cheat

Total Allmedics1 Other Other 7 otherAge of mother mo:;:r~ exami- Pe1- related related Photo- examinot

nation to to fluoro- :;:: nationsvimetry preg- preg- graphicnancy nancy


Total---- ] 100.OI 100.OII 100.0{ 100.01 loo.oj 100.OI1OO.OI 100.0

Under 20 yeara- 14.4 15.0 20.0 13.9 20.9 14.5 16.5 20-24 years---- 35.4 37.2 42.1 3%: 23.4. 35.6 37.6 26.6 25-29 years---- 25.0 21.7 16.6 22.3 27.9. 17.8 23.4 23.0 30-34 years---- 14.9 15.1 14.0 19.5 11.2 13.7 13.9 24.9 35+ years 10.1 11.0 7.3 13.7 23.6 12.0 10.6 9.0

oftherelationship— ..- edlya function betweenhigher Previous Pregnancy Experience

parityand increasingage. The rateforotheroftheabdomen relatedtopregnancy As might be expected,the rate of X-rayexaminations

appears generallyto risewithage.The rates pelvimetryforprimiparouswomen wassignififor examinationsof thechestappearnotto be cantlyhigher thanthatformultiparouswomen

8). (tablerelatedtoage (table E).Elevenwomen perlOOwitb noprevious

Table E. Medical X-ray examinationrates during pregnancy, by type of examination andlive-birth order: United States, 1963

Total Abdomen AllotherLive-birth order medics1 Chest examiexami

nations Total Pe1- Other nationsvimetry

Rate per 100 women

Total 27 10 5 5 16 1

..Firstlive birth 35 16 11 5 18 1Second live birth 7 4 1Third or fourth live birth $: ,: 5 ;2 1Fifth live birth or more------------ 27 1: 3 7 15 2

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pregnancyhad X-ray pelvimetryas comparedwith only 2 per 100 withthirdor fourthorderbirths.There is some evidenceto sugg&stthatotherexaminationsof theabdomen have some-what higherratesat highparities.Itshouldbekeptinmind thattheseareolderwomen who mayexperiencea differentpatternofmorbiditythanthoseatlowparities.The rateofchestexaminations appears to be unrelatedto birthorder(tablesE and9).

At eachparity,themedicalX-rayexaminationrateseems significantlyhigherforwomen whohave had one fetalIoss or more priortothepresentpregnancy(tableF). For women havinga firstlivebirth, rateforthosetheexaminationwitha previousfetaIlosswas 42per100comparedwith only 35 per 100 women withno previouspregnancy.Similardifferentialswere observedat each of theotherparities.Again,most ofthe

is representedby examinationsdifference ofthe

Table F. Medical X-ray examination rates during pregnancy, by type of examination andpregnancy history: United States, 1963

Total Exami- Exami- Allmedical nation nation otherPregnancy history exami- of of examinations abdomen chest nations

All live births Rate per 100 women

Total-------- 27

No fetal death prior to this live birth----------- 27One fetal death or more prior to this live birth-- 31

First live birth

Total--------- 35

No fetal death prior to this live birth-----------One fetal death or more prior to this live birth-- :;

Second live birth

-.~ ~~$i..%y 23


Third or fourth live birth

Total--------------------------------------- 23


Fifth live birth or more /

Total-----------------.-..-s. 27


10 ==Ql==J 16 .x--’-16 ;

,//.

18 I 1 “

1#~ 18 1 27 * *

- r 7 15 I 1

I

15 1 15 15 *

.

7 15 1— -i--

14 116 *

15 2

A_! 9

-------------

--------------------------

-----------------------------------

--------------------------

---------------------------------------

------------------------------

.. ~.

abdomen. Examinations of the chest do not appear

to be significantly related to previous history of fetal loss during pregnancy.

Color and Family Income

The rate of medical X-ray examinations during pregnancy does not generally appear to be

related to income (tables 10 and 11). However, the

data do suggest that the rate of chest examinations,

particularly for white mothers, declines with

increasing income. This differential may reflect the concentration of chest screening programs

among the lower income segments of the population.

COMPARISON WITH RATES FOR

WOMEN IN GENERAL POPULATION

Medical X-ray visit rates derived from the

1963 National Natality Survey were compared with similar data for women aged 15-44 years

in the general population. The latter data were derived from the 1960-61 Household Interview Survey of the National Health Survey. 1 To fa

~k cilitate the comparison, X-ray visit rates during

~~gnancy have been adjusted oh an annual basis.p..% ‘fhe annual medical X-ray visit rate of 59

per 100 women estimated for the general Popula

tion is sigfit!l.c+ntly higher than the estimate Of

35 per 100 pregn5Rt w-omen. A comparison of visit rates by age group, color, geographic region, and

type of examination (table G) indicates that for all of these characteristics the estimated annual visit rates applicable to pregnant women are significantly lower than those found for women aged 15-44 in the general population. It is likely

that the lower rates for pregnant women result both frf;m a generally better health status enjoyed “by wqnen who deliver a live birth than by women in the general population and from the increasing

attention given by physicians to the possible risks of X-ray examination of pregnant women.

Table G. Comparison of medical ‘ . visit rates for women during pregni “ with those for women in the genet. population, by selected characteristics

1General During Characteristic popula- preg

tion nancy

Rate per 100 womena

Total 59 35

Age

15-29 years 30-44 years

Color

White Nonwhite

Geographic region

NortheastNorth CentralsouthWest

Type of examination

ChestOther medical

aPregnancy data are based on X-ray examinations reported during pregnancy, ex-pressed as annual visit rates per 100 pregnant woxpen. General population data are based on National Health Survey estimates for women aged 15r-44fl. ywr>””-~.Y ra,ces,. .axs est~fited pkm 10Ci women in the civillan, noninstitutional population.

10

REFERENCES

lU.’S. National Health Survey: Volume of X-ray visits. Heai!th Statistics. PHS Pub. No. 584B38. Public Heidth Service. Washington. U.”S. Government Printing Office, Oct. 1962.

2National Center for Health Statistics: Methods and response characteristics, National Natality Survey, United States, 11963,vital and Health Statietrb. PHS Pub. No. 1000-Series 22-No. 3. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1966.

%atiord Center for Health Statistics: Replication, an approach to the analysis of data from complex surveys. Vii%t and HeaZt7i Statistics. PHS Pub. No. 1000+eries 2-No. 14. Public Health Service. Washington. U.S. Government Printing Office, Apr. 1966.

?National Centerfor Health Statistics: Episodes and duration of hospitalization in the last year oflife, United States, 1961. VitaZ and Hea2th Statistics. PHSPuh. No. 1000-Series 22-No.2. Public Health Service. Washington. U.’S.Government Printing Office, June 1966.

5U.S. Bureau of the Census: U.S. Censw of Population, 1960. Vol I, Characteristics of the Population. Part I, United States ‘Summary,Washington. U.S. Government Printing Office, 1964. pp. XXXI and XXXIL

000

11

-------------------------------------------

Table 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

DETAILED TABLES

Number of all mothers and nuber and percent of all mothers with one medicalX-ray visit or more during pregnancy, by color and age of mother: United states,1963----------------------------------------.------------.-----------------------

Number and rate per 100 mothers of medical X-ray visits and examinations during pregnancy for all mothers, and visit and examination rate for mothers with one medical X-ray visit or more, by age of mother and color: United States, 1963-----

Number and rate per 100 mothers of medical X-ray visits and examinations duringpregnancy for all mothers, and visit and examination rate for mothers with onemedical X-ray visit or more, by geographic region and metropolitan and nonmetropolitan area: United States, 1963--......----------------..............----------

Number and rate per 100 mothers of medical X-ray visits and examinations duringpregnancy for all mothers, and visit and examination rate for mothers with onemedical X-ray visit or more, by color and familY income: United ‘tates~ 1963-----

Number of X-ray examinations during pregnancy, by type of examination and type offacility: United States, 1963--------------------------------.--.....------------

Number of X-ray examinations during pregnancy, by type of examination, trimesterof examination, and age of mother: United States, 1963---------------------------

Number of X-ray examinations during pregnancY, by tYPe of examination, color, andage of mother: United States, 1963--------.---------.-..---------------.---.-----

Rate of X-ray examinations per 100 women during pregnancy,by type of examination,color, and age of mmther: United States, 1963------------------------------------

Number of X-ray examinations during presnancy,by tYPeof examination and Pre@ancyhistory: United States, 1963----------

Number of X-ray examinations during PresnancY, by tYPe of examination, cOIOr, andfamily income: United States, 1963-----------..-------.--..--..------------------

Rate of X-ray examinations per 100 women during pregnancy,by type of examination,color, and family income: United States, 1963------------------------------------

Page -

13,r

14

15

16

16

17

18

19

20

21

22

12

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Table 1. Number of all mothers and number and percent of all mothers with one medical X-ray visitor more during pregnancy,by color and age of mother: United States, 1963

Mothers with onemedicalX-ray visit

All or more duringmothers pregnancy

Color and age of mother inthousands

\

Under

20-24

25-29

30-34

Total

All ages

20 years

years

years

years

Number Percentin of all

thousands mothers

4.071 915 22.5

588 142 24.1

1,442 347 24.1

1,018 189 18.6

608 140 23.0

35 years and over 412 94 22.8

White

All ages ------------------ 3,414 744 21.8

Under 20 years 451 101 22.4

20-24 years 1,228 294 23.9

25-29

30-34 years

35 years and over

Under

20-24

25-29

30-34

Nonwhite

All ages ---------

20 years-----.---

years

years

35 years and over ------.-

871 148 17.0

515 118 22.9

347 81 23.3

656 L70 25.9

137 40 29.2

214 52 24.3

147 41 27.9

92 22 23.9

63 13 20.6

13

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---------

Table 2. Number and rate per 100 mothers of medical X-ray viaits and examinations during pregnancy for all mothers, and visit and examination rates for mothers with one medical X-ray visit or more, by color and age of mother: United States, 1963

Medical X-ray visits and One medical X-ray Visit examinations during pregnancy or more

Color and age of mother Tumber of“’’rat+= mothersEIEiiE EIEiiz

Number in thousanda Rate per 100 iumber in Rate per 100

mothers :housands mothers

All agea 4,071 1,085 1,120 26.7 I 27.5 915 118.6 122.4

Under 20 years------------ 588 162 167 27.6 28.4 142 114.1 117.6

20-24 years 1,442 409 418 28.4 29.0 347 117.9 120.5

25-29 years 1,018 228 242 22.4 23.8 189 120.6 128.0

30-34 years 608 164 169 27.0 27.8 140 117.1 120.7

35 years and’over--------- 412 118 122 28.6 29.6 94 125.5 129.8

White

All ages 3,414 870 893 25.5 26.2 744 116.9 120.0

Under 20 years------------ 451 119 123 26.4 27.3 101 117.8 121.8

20-24 years 1,228 339 346 27.6 28.2 294 115.3 117.7

25-29 years 871 180 188 20.7 21.6 148 121.6 127.0

30-34 years--------------- 515 132 133 25.6 25.8 118 111.9 112.7

35 years and over--------- 347 97 101 28.0 29.1 81 119.8 124.7

Nonwhite

All age’s 656 214 227 32.6 34.6 170 125.9 133.5

Under 20 yeara------------ 137 43 43 31.4 31.4 40 107.5 107.5

20-24 years--------------- 214 70 72 32.7 33.6 52 134.6 138.5

25-29 years 147 48 54 32.7 36.7 41 117.1 131.7

30-34 years 92 32 35 34.8 38.0 22 145.5 159.1

35 years and over 63 20 20 31.7 31.7 13 153.8 153.8

14

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--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

---------------

--------------

-----------

Table 3. Number and rate per 100 mothers of medical X-ray visits and examinations during pregnancy for all mothers, and visit and examination rates for mothers with one medical X-ray visitor more, by geographic region and metropolitan and nonmetropolitan area: United States, 1963

Medical X-ray visits and One medical X-ray visit examinations during pregnancy or more

Geographic region and ,,,Al. .L

metropolitan status mothers

Visits Exami-nations

N;~tmnbr;f Visits Exami-nations

-) I

All regions Number in thousands Rate per 100 mothers

Number in Rate per 100 thousands mothers

Total 4,071 1,085 1,120 26.7 27.5 915 118.6 122 � 4

I I

Metropolitan 2,639 775 801 29.4 30.4 650 119.2 123.2

Nonmetropolitan 1,431 310 319 21.7 22.3 265 117.0 120.4

Northeast

Total 936 237 245 25.3 26.2 201 117.9 121.9

171 119.9Metropolitan 750 205 212 27.3 28.3 --L 124.0

Nonmetropolitan 186 32 33 17.2 17.7 29 110.3 113.8

I North Central

Total 1,133 315 325 27.8 28.7 279 112.9 116.5

Metropolitan 711 219 227 30.% 31.9 193 113.5 117.6


South

Total 1,316 323 337 24.5 25.6 127.7

Metropolitan 670 189 198 28.2 29.6 -4-= 130.3


West

Total 684 208 212 30.4 31.0 170 122.4 124.7

Metropolitan 507 160 163 31.6 32.1 132 121.2 123.5--t


15

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-----------

-----------

-----------------

----------------------------

----------------------------------

--------------------

Table 4. Number and rate per 100 mothers of medical X-ray visits and examination during pregnancy for all mothers, and visit and examination rates for mothers with one medical X-ray visitor more, by color and family income: United ‘States, 1963

I Medical X-ray visits and One medical X-ray visitexaminations during pregnancy or more

Color and familyincome

Exami- Number of“’w==Visits nations mothers

Total Number in thousands Rate per 100 Number in Rate per 100

mothers thousands mothers

All incomes 4,071 1,085 1,120 26.7 118.6 122.4===4=== Under $2,000-------------- 458 131 134 28.6 29.3 114 114.9 117.5 $2,000-$3,999------------- 838 259 271 30.9 32.3 209 123.9 129.7 $4,000-$6,999------------- 1,473 382 397 25.9 27.0 322 118.6 123.3 $7,000 and over 973 224 227 23.0 23.3 197 113.7 115.2 Not ascertained 327 85 88 26.0 26.9 71 119.7 123.9

White

1% All incomes--------- 3,414 870 893 25.5 26.2 744 116.9 120.0

Under $2,000-------------- 274 79 28.8 29.2 116.’2 117.6 $2,000-$3,999------------- 686 199 2% 29.0 30.5 119.2 125.1 $4,000-$6,999------------- 1,363 343 352 25.2 25.8 290 118.3 121.4 $7,000 and over----------- 939 220 223 23.4 23.7 193 114.0 115.5 Not ascertained 149 25 25 16.8 16.8 23 108.7 108.7

Nonwhite

All incomes--------- 656 214 227 32.6 34.6 170 125.9 133.5

Under $2,000-------------- 183 27.9 29.0 46 110.9 115.2 $2,000-$3,999------------- 151 39.1 41.1 41 143.9 151.2 $4,000-$6,999------------- 109 35.8 41.3 31 125.8 145.2 $7,000 and over----------- 100.0 100.0 Not ascertained 1% 59 3;:: 3;:: 125.5 131.9

Table 5. Number of X-ray examinations during pregnancy, by type of’examination and type of facility: United States, 1963

II Abdomen II

A.Total Other

Allmedical Other other

Type of facility exami- Pel- related not Chest examinations to

related nationsvimetry preg- to

pregnancy nancy

Number of X-ray examinations

AH facilities-------------------- WI 209,000 158,000 47,000 648,000 56,000

I I I I

Physicians’ offices

General practitionersObstetricians and gynecologistsOthers

All other places 935,000 163,000 121,000 40,000 569,000 42,000 II I I I 1

e’

16

I

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--------------------

----------------------------------

-----------------

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--------------------

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-----------------

-----------------

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--------------------

--------------

Table 6. Number of X-ray examinationsduring pregnancy,by type of examination,trimesterof exand age of mother: United States, 1963arnination,

Abdomen Chest

Tota1 Allmedical Other Other other

Trimesterand age of mother exami- Pel- related not Photo- examire~oted .fl~oro- Other nations

‘onations vimetry preg- preg- graphic chest

nancy nancy

Total Number of X-ray examinations

All ages 1,117,000 209,000 158,000 47,000 84,000 564,000 56,000

Under 20 years 167,000 42,000 11,000 7,000 18,000 82,ooO 9,000

20-24 years 415,000 88,000 60,000 11,000 30,000 212,000 15,000

25-29 years 243,000 35,000 35,000 13,000 15,000 132,000 13,000

30-34 years 169,000 29,000 31,000 5,000 12,000 78,000 14,000

35 years and over 123,000 15,000 22,000 11,000 10,000 60,000 5,000

First trimester

All ages 232,000 1,000 3,000 27,000 15,000 164,000 22,000

Under 20 years 28,000 1,000 4,000 2,000 17,000 4,000

20-24 years 84,000 1,000 6,ooO 5,000 64,000 8,000

25-29 yeara 55,000 1,000 8,000 3,000 35,000 7,000

30-34 years 30,000 1,000 2,000 25,000 2,000 35 years and O~er 35,000 1,000 8,000 2,000 22,000 2,000

Second trimester

All ages 280,000 4,000 9,000 8,000 24,000 217,000 19,000

Under 20 yeara 48,000 1,000 8,000 36,000 3,000

20-24 years 97,000 2,000 2,000 7,000 81,000 4,000

25-29 years 63,000 1,000 3,000 3,000 6,000 48,000 3,000

30-34 years 48,000 1,000 3,000 1,000 1,000 33,000 8,000

35 years and over 25,000 2,000 1,000 1,000 1,000 19,000 1,000

Third trimester

All ages 605,000 204,000 146,000 13,000 45,000 183,000 15,000

Under 20 years 92,000 41,000 11,000 2,000 7,000 29,000 3,000

20-24 years 234,000 88,000 56,000 3,000 17,000 66,000 3,000

25-29 years 125,000 34,000 31,000 3,000 5,000 49,000 3,000

30-34 years 91,000 28,000 28,000 3,000 8,OOO 20,000 4,000

35 years and over 63,000 13,000 20,000 2,000 7,000 19,000 2,000

17

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--------------------

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-----------------

-----------------

--------------------

--------------------

--------------------

--------------

Table 7. Number of X-ray examinationsduring pregnancy, by type of examination, color, and ageof mother: United States,1963

Abdomen Chest

Total Allmedical Other Other otherColor and age of mother exami- Pel- related related Photo- examinot

to fluoro- Other nationsnations vimetry preg- to chestpreg- graphic

nancy nancyr


All ages 1,117,000 209,000 158,000 47,000 84,000 564,000 56,000

Under 20 years 167,000 42,000 11,000 7,000 18,000 82,000 9,000

20-24 years 415,000 88,000 60,000 11,000 30,000 212,000 15,000

25-29 years 243,000 35,000 35,000 13,000 15,000 132,000 13,000

30-34 years 169,000 29,000 31,000 5,000 12,000 78,000 14,000

35 years and over 123,000 15,000 22,000 11,000 10,000 60,000 5,000

White

All ages 893,000 182,000 136,000 30,000 60,000 438,000 47,000

Under 20 years 123,000 34,000 6,000 7,000 8,000 61,000 9,000

20-24 years 346,000 79,000 55,000 7,000 22,000 170,000 13,000

25-29 years 188,000 30,000 27,000 9,000 10,000 99,000 12,000

30-34 years 133,000 25,000 29,000 4,000 11,000 58,000 7,000

35 years and over 102,000 14,000 19,000 3,000 10,000 51,000 5,000

Nonwhite

All ages 224,000 27,000 22,000 17,000 24,000 125,000 9,000

Under 20 years 44,000 8,000 5,000 . 10,000 21,000

20-24 years 69,000 9,000 5,000 4,000 8,000 42,000 2,000

25-29 years 55,000 4,000 8,000 4,000 5,000 32,000 1,000

30-34 years 36,000 5,000 2,000 1,000 1,000 21,000 7,000

35 years and over 21,000 1,000 2,000 8,000 9,000

18

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----------------------

----------------

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----------------------

----------------------

----------------------

----------------

Table 8. Rate of X-ray examinations per 100 women during pregnancy,by type of examination, color,and age of mother: United States, 1963

I Abdomen I Chest I Total AllOthermedical Other otherColor and age of mother examirelated not Photo- examinations Pel- to related

fluoro- Other nationsvimetry to chestpreg- preg- graphicnancy nancy

Total Rate per 100 women

7$ All ages 27.4 5.1 3.9 1.2 2.1 13.8 1.4

Under 20 years 28.5 7.1 1.8 1.1 3.0 14.0 1.6

20-24 years 28.8 6.1 4.1 0.8 2.1 14.7 1.0

25-29 years 23.8 3.4 3.4 1.3 1.5 12.9 1.3

30-34 years 27.8 4.8 5.0 0.9 1.9 12.8 2.3

35 years and over 29.8 3.7 5.3 2.7 2.5 14.5 1.2

White

All ages 26.1 5.3 4.0 0.9 1.8 12.8 1.4

Under 20 years 27.4 7.5 1.3 1.4 1.7 13.5 2.1

20-24 years 28.2 6.5 4.5 0.6 1.8 13.8 1.0

25-29 years 21.6 3.5 3.1 1.0 1.1 11.4 1.4

30-34 years 25.8 4.8 5.6 0.8 2.0 11.2 1.4

35 years and over 29.3 4.0 - 5.6 0.9 2.9 14.5 1.5

Nonwhite

All ages 34.2 4.1 3.3 2.6 3.7 19.1 1.4

Under 20 years 32.1 5.9 3.6 7.3 15.3

20-24 years 32.2 4.0 2.2 1.7 3.8 19.5 1.0

25-29 years 37.1 3.0 5.4 2.8 3.4 22.1 0.5

30-34 years 38.5 5.1 2.0 1.0 1.0 22.3 7.1

35 years and over 32.6 1.8 3.6 12.7 14.5

19

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--------------------

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--------

--------------------

--------------------

------------

---------

--------------------

--------------------

------------

--------

--------------------

--------------------

------------

---------

--------------------

--------------------

Table 9. Number of X-ray examinations during pregnancy,by type of examination and pregnancy his-tory: Uni’tedStates, 1963

II I 1

II Abdomen I Chest I Total All

medical m Other otherPregnancy history not Photo- examirelated f~uoro- Other nationsto graphic chest

pregnancy

I

Number of X-ray examinations

Total live births .,117,000 209,000 158,000 47,000 84,000 564,000 56,000 ‘

No fetal death prior to this (

live birth-------------------- 996,000 188,000 137,000 40,000 78,000 507,000 47,000 One fetal death prior to this live birth 100,000 15,000 17,000 6,000 6,000 45,000 10,000

Two fetal deaths or more prior 5,000

I?ixstlive birth 404,000 128,000 38,000 15,000 29,000 179,000 15,000

to this live birth------------ 22>000 1 4,000 1,000 11,000

No fetal death prior to thislive birth 388,000 124,000 33,000 12,000 28,000 175,000 15,000

One fetal death prior to thislive birth 12,000 3,000 3,000 2,000 1,000 3,000

Two ‘fetaldeaths or more priorto this live birth + + * J6 J$ + +.

Second live birth 224,000 33,000 27,000 6,000 15,000 131,000 12,000


One fetal death prior to thislive birth 22,000 7,000 4,000 1,000 9,000 1,000

WO fetal deaths or more priorto this live birth * + + * w * +

Third live birth 186,000 16,000 41,000 4,000 17,000 102,000 7,000

No fetal death prior to thislive birth 168,000 15,000 35,000 4,000 17>000 91,000 6,000

One fetal death prior to thislive birth 17,000 1,000 5,000 9,000 1,000

Two fetal deaths or more priorto this live birth + + + % Y. + ?-

{Fourth live birth 105,000 9,000 17,000 6,000 3,000 61,000 8,000


One fetal death prior to thislive birth 13,000 1,000 1,000 10,000 {

Two fetal deaths or more priorto this live birth * * * * * * *

Fifth live birth 199,000 23,000 36,000 17,000 19,000 90,000 14,000


One fetal death prior to thislive birth 36,000 4,000 3,000 4,000 4,000 13,000 8,000

‘ho fetal deaths or more priorto this live birth------------ 12,000 3,000 2,000 1,000 5,000

20

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Table 10. Number of X-ray examinationsduring pregnancy,by type of examination,color, and family income: United States, 1963’

II Abdomen I Chest I Total Allmedical Other Other othernotColor and family income exami- Pel- related related Photo- examinations vimetry ‘0 to fluoro- Other nations

preg- preg- graphic chest

nancy nancy


All incomes 1,117,000 209,000 158,000 47,000 84,000 564,000 56.000

Under $2,000-------------------

$2,000-$3,999

$4,000-$6,999

$7,000and over

Not ascertained

White

All incomes

Under $2,000-------------------

$2,000-$3,999

$4,000-$6,999

$7,000 and over

Not ascertained

Nonwhite

All incomes

Under $2,000-------------------

$2,000-$3,999

$4,000-$6,999

$7,000 and over

Not ascertained

134,000 24,000 16,000 5,000 12,000 74,000 3,000

271,000 46,000 38,000 16,000 16,000 141,000 13,000

398,000 79,000 66,000 17,000 25,000 191,000 20,000

229,000 49,000 32,000 8,000 15,000 109,000 17,000

85,000 11,000 6>000 1,000 17,000 48,000 3,000

893,000 182,000 136,000 30,000 60,000 438,000 47,000

81,000 16,000 10,000 4,000 5,000 42,000 3,000

209,000 41,000 32,000 7,000 13,000 107,000 9,000

353,000 72,000 61,000 12,000 23,000 167,000 18,000

225,000 49,000 32,000 8,000 14,000 106,000 17,000

25,000 3,000 1,000 5,000 16,000

224,000 27,000 22,000 17,000 24,000 125,000 9,000

54,000 8,000 5,000 2,000 6,000 32,000

61,000 4,000 6,000 9,000 4,000 34,000 5,000

45,000 7,000 6,000 5,000 2,000 24,000 2,000

* * * * * * *

60,000 8,000 5,000 l,QOO 12,000 32,000 3,000

21

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------------------

----------------

------------------

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------------------

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Table 11. Rate of X-ray examinations per 100 women during pregnancy, by type of examination,color, and family income: United States, 1963

Abdomen Chest

Total AllOthermedical Other otherColor and family income examinot

nations Pel-related related Photo- Other exami

vimetry to to fLlo-ro- chest nations

Total

All incomes

Under $2,000---------------------

$2,000-$3,999

$4,000-$6,999--------------------

$7,000 and over

Not ascertained

White

All incomes

Under $2,000---------------------

$2,000-$3,999--------------------

$4,000-$6,999--------------------

$7,OOO and over

Not ascertained

Nonwhite

All incomes----------------

Under $2,000---------------------

$2,000-$3,999--------------------

$4,000-$6,999--------------------

$7,000 and over

Not ascertained

preg- graphicpregnancy nancy

Rate per 100 women

27.4 5.1 3.9 1.2 2.1 13.8 1.4 — ;

29.3 5.3 3.4 1.2 2.5 16.2 0.7

32.3 5.5 4.5 1.9 2.0 16.8 1.6

27.0 5.4 4.5 1.1 1.7 13.0 1.3

21.3 4.5 2.9 0.7 1.4 10.2 1.6

26.1 3.3 1.9 0.3 5.1 14.7 0.9

26.2 5.3 4.0 0.9 1.8 12.8 1.4

29.4 6.0 3.8 1.4 1.9 15.3 1.2

30.5 6.0 4.7 1.0 1.9 15.6 1.3

25.9 5.3 4.4 0.9 1.7 12.3 1.3

24.0 5.2 3.4 0.8 1.5 11.3 1.8

17.1 2.1 0.6 3.4 11.0

34.2 4.1 3.3 2.6 3.7 19.1 1.4

29.2 4.3 2.8 0.9 3.5 17.6

40.6 2.9 3.9 6.1 2.3 22.4 3.0

41.6 6.4 5.1 4.5 1.6 22.1 1.8

9< * * * * * 7’<

33.9 4.2 3.0 0.5 6.5 18.0 1.7

-

22

APPENDIX I

TECHNICAL NOTES ON METHODS

‘1 Statistical Design of National Natality Surviey

Survey pYoceduves.—The procedures used for the National Natality Survey maybe viewedas anextension of the birth registration system of the United States. The birth record was used as the sampling unit, and births to be included in the survey were selected from the frame of records representing all registered births. The survey was conducted Imth with primary sources of information identified on the birth record (mother of child, attending physician, institution of birth) and with referral or secondary sources reported by a primary source (other physicians who saw or treated the mother, other institutions at which the mother received care, and dentists from whom the mother received care).

The principaI method of data collection for the National Natality Survey was by mail questionnaire. Mailing addresses for primary sources were almost always reported on the birth certificate or were readily ascertained by consulting available directory sources. Mailing addresses of referral or secondary sources were usually reported by the primary sources identifying these reporters. Provision was also made for collecting data by means other than mail, including telephone and personal interviews.

In order to facilitate sampling of births, tie sample was selected from the file of microfilmed birth records which were received at approximately monthly intervals by the NationaI Center for Health Statistics (NCHS) from the 54 birth-registration areas of the United States. As a general rule, these microfilm images are assigned a number prior to or during filming of the birth record by each of the registration areas. Each thousand consecutively numbered images are defined as a !‘reel” and are assigned an identifying reel number starting with zero. Within each reel, the images were numbered from 1 to 1,000.

The sampling for the survey was based on a probability design which used these preassigned reel and image numbers on the birth records. Each reel was considered a primary sampling unit; within each reel, one record was chosen on a random basis. Thus a sam

ple of 1 out of every 1,000 births was selected from the monthly shipment of records from the registration areas. This procedure produced a sample of 4,096 births for the year 1963.

As copies of the selected birth certificates were received in NCHS, they were reviewed to ascertain which sources would be queried and at what addresses. For all births occurring in institutions (primarily hospitals) a questionnaire as shown in Appendix III was prepared for mailing. Information was requested about care received during the l-year period preceding the date of birth, in particular, care involving X-ray examinations or treatments. The attendant at birth was also queried for similar information, except for those caaes where the attendant signing the certificate was an intern at the hospital where the birth occurred. With the exception of births reported as illegitimate or inferred to be illegitimate on the baais of indirect evidence from the birth certificate, a questionnaire was also prepared for mailing to the mother (Appendix 111). Tlis questionnaire was devised to obtain the names of physicians, dentists, clinics, and hospitala from which the mother had received care during the year prior to the birth of her child and also to obtain such information as education, family income, and employment during pregnancy.

Any physicians, clinics, hospitals, or dentists identified by the mother as having provided care during the l-year period who had not already been queried were subsequently queried for information on X-ray treatments or examinations received by the mother.

Followup mailings were routinely sent to all sources not responding to the original questionnaire. Additional mailings were also made to obtain complete and consistent information on questionnaires rejected as “in-adequate’ by a concurrent editing procedure. A more detailed description of survey procedures used in the National Natality Survey can be found in another report in this series. 2

Estimating methods. —The statistics shown in this report are estimates prepared by means of a post-

23

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stratified ratio estimation procedure. This procedure was used for each of the following groups:

Group Age of mother Color

Live-birth order

1 2-------

:-------

Under 20 years1-19 years 20-24 years 20-24 years 20-24 years

White White White White White

1 2+ 1 2 3+

2------- 25-29 years White 1

:-------9-------1o------11------12------13------14------15------

25-29 years 25-29 years 25-29 years 30-34 years 30-34 years 30-34 years 35t years 35+ yearsUnder 20 years

White White White White White White White White Nonwhite

3-:

1-? 3-4

5+ 1-4

5+ 1

16------17------

Under 20 years 20-24 years

Nonwhite Nonwhite 1-?

18------ 20-24 years Nonwhite 3+ 25-29 years Nonwhite

%----- 25-29 years Nonwhite 21------ 25-29 years Nonwhite

30-34 years Nonwhite %----- 30-34 years Nonwhit~ 24------ 35+ years Nonwhite

The national count of births was obtained for each of the 24 groups, andthe ratio of this count to the sample count was determined. Each birth in the group was then assigned a constant weight so that the sum of the weights equalled the national total for thatgroup.

Rounding of numbws. —l%e tabulations on which the tables inthis report were based showfiguresto the nearest unit, except for selected tables inwhichfigures were truncated to the nearest thousand in tabulation. The tables in this report have all been roundedor truncated to the nearest thousand. Neither numbers nor derived figures such as percents, rates, and aver-ages are necessarily accurate in the detail shown.

Reliability of Estimates

The errors to which a survey such as the National Natality Survey is subject may be conveniently grouped into two classes. On the one hand, the statistics derived from the survey are estimatesbased onasample rather than on a complete enumeration. Such estimates are subject to variability from the figure which might have been obtained had a survey covering all births been conducted using the same questionnaires and procedures. Apart from sampling errors, theresults of such a survey are also subject to errors of measurement, which may include those errors which arise from formation of concepts, ambiguities in definition, construction of the questionnaire, nonresponses or incomplete

responses, and problems associatedwiththeprocessing of survey data (such as coding errors, editing mistakes, and tabulation errors).

Sampling ewor. —The standard error is primarily a measure of the sampling variations that occur by chance because only a sample rather than an entire ppulation is surveyed. The chances are about 680ut of 100 that an estimate from the sample differs from the value obtained from a survey of the entire popu-Iation by less than the standard error. The chances are about 95 outof 100 that the difference is less than twice the standard error.

The relative standard error of an estimate is obtained by dividing the standard error of the estimate bytheestimate itselfi itisexpressedas a percentage of the estimate.

The variance ofastatistic depends notordy on the design of the sample, butalso onthedistribution of the statistic itselfi the variance is greater for measurements which are highly variable from one individual to another and lower for measurements which are less variable. Since the estimates of the sampling error are obtained from the sample data, they are themselves subject to sampling error, which may be large in some instances.

Estimates of sampling variability for the statistics derived from this survey were based on 20 random half-sample replications. This technique yields overall estimates of variability through observation of variability among random subsamples of the total ssmple. It reflects both the error that arises from sampling andapart of the measurement error; itdoesnot, how-ever, measure any systematic biases in the data. A general discussion of the development and evaluation of a replication technique for estimating varisnce has been published.3 The procedures and computations used to estimate variances by this method in the 1963 National Natality Survey are briefly described below.

For the survey each record from the entire file of records was assigned systematically to a random group betweenl and 40. Twenty pairsofrandom groups were created from these40 groups. Ahalf sample was formed by randomly selecting one group from eachof the 20 pairs. This process was repeated until 20 replicate

\half samples were formed from which vari

ance estimates were derived. The composition of the 20 half samples shown intable Iwasdetermined by an orthogonal plan.

After the composition of each of the half samples was determined, the estimation procedures used to produce the final estimates from the entire sample were applied separately to each of the resulting half samples. An estimated variance S: of an estimated statistic X’ of the parameter is obtained by applying the following formula:

24

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-------- --------- ------------ ----

------------------------

----

Table I. Composition of the 20 half-sample replicates

Half-sample Bandom groups includedreplicates

;--------------------13 18

17 19 20

23 26 24 26

28 32 31

38:2 3 :: 18 19 24 26 % 34 35 L--------5-------------------- 10

13 14 15 ::

20 20 3. 27

27 33 33

35 36

6--------“------- 13 16 18 23 28 34 36 37 1; 14 16 18 % 23 27 35 37

;---------------------q-------------”-.

9 10

14 14

16 16

18 17

19 19

24 32 31

% 33

35 37 35 37

id------------------- 5810 14 15 17 20 31 33 35 38 11-------------------2 6810 15 18 19 12-------------------1 6810 :: 16 19 27 :: 13-------------------2 689 14 15 ;; 20 23 25 27 36 AL------------------- 2 id-------------------2 16-------------------2

67 7 8

1; 9

13 13 14

18 18 17

20 19 19

23 25 23 25 23 26

27

;;

35

% 17-------------------1 7 14 17 19 24 25 36 18------------------- 7 1: 13 17 19 23 26 36 19------------------- ; 8 10 11 13 15 17 20 24 25 iii------------------ 2 8 10 12 14 16 18 20 24 26 % 38

—

where Table III. Approximate standard errors for estimated percentages shown in this report

x!is the estimateofXbasedontieentire sample,andXiii is the estimate of Xbasedonthe ithhalfsample. Estimated percent

Base ofEstimates ofstativd ~ors. -Approximate rela- percentage 2 5 10 20 30 tive standard errors andcorrespondingstandarderrors or or or 50of estimated numbers are shown in table II. Table III 98 E 90 E 70

contains the approximate standard errors for the esti- I J I 1 I t

mated percentages. Relative standard errorsofnumber Standard errorof medical X-ray examinations or visits are given in

6.4tsble IV. Table V presents estimates of relative stand- 30,000----- 2.0 3.1 4.2 R 5.050,000----- 1.5 2.4 arderrors ofmedical X-ray visitor examinationrates 100,000---- 1.1 1.7 H 3.1 3.5 bythesize of the baseonwhichthe rate was calculated. 250,000---- 0.7 1.5 1.9 2.2

Difference between two sample estimates. —The 500,000---- 0.5 ;:$ 1.6 1,000,000-- 0.3 0.5 H M

standard error of a difference is approximately the 2,000,000-- 0.2 0.5 0.7 ::: square root of the sum of the squares ofeach standard 3,000,000-- 0.2 !:$ 0.4 0.6 0.6

4,000,000-- 0.2 0.3 0.4 0.5 0.5JTable II. Approximate standard errors for es

timated numbers shown in this report error considered separately. ‘This formula will represent the actual standard error quite accurately for the

Relative difference between separate and uncorrelated charac-

Size of estimate standard Standard teristics although it is in fact only an approximation.err or error EWOYS associated with. nonrespo~e.-Appro&pk~nt mately 14percent of tie forms mailed tomothers were

either not returned or were returned with the needed 25,000--------------------- 16.8 4,200 information incomplete .Thecorresponding nonresponse50,000--------------------- 12.0 6,OOO rate was about 7 percent for physicians and about 275,000--------------------- 7,350 100,000-------------------- ::; 8,500 percent for medical facilities. A more complete dis-250,000-------------------- 5.0 12,500 cussion of nonresponse and response characteristics 500,000-------------------- 3.3 16,500 in this survey will be found in another report in this750,000-------------------- 18,750 1,000,000------------------ ;:: 20,000 series.4 Of primary concern in the design oftheNa-1,500,000------------------ 1.5 22,500 tional Natality Survey was the probable impact ofnon

response on the completeness ofcoverageof the X-ray

25

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Table IV. Relative standard error of number of value of the total number of examinations which would X-ray examinations or visits have been reported had there been no nonresponseis

equal to the number of such examinations reported

Number of Relative Number of Relative weighted by the inverse of theresponseratesfrom each standardexaminations error in examinations standard type of reporting source. Thus for examinations re-

in thousands percent in thousands error in ported only by a physician, theestimated total numberpercent of such examinations would be equalto 100/93 multi-plied by the actual number of reported examinations.

28.0 3oo---------H----------- 19.8 350--------- ::; For examinations which were reported by more than

30----------- 16.0 4oo--------- 4.4 one source (which amounted to about 30percent ofaH40----------- 14.0 450--------- 4.1 examinations), it may be shown that the joint proba-50----------- 12.4 5oo--------- 3.9 bility of nonresponse from two sources is virtually75----------- 10.2 600---------1oo---------- 8.8 7oo--------- ;:: zero.125---------- 7.8 800--------- 3.1 Table VI presents estimates of the number of ex-150---------- 9oo--------- aminations reported in the survey and the estimated175---------- ;:: l,ooo ;::2oo---------- 6.2 1,500------- 2.2 number including adjustment for nonresponse.250---------- 5.6 2,000------- 1.9 EYYOVassociated with incomplete vesponse. —Non-

response to items on questionnaires returned by the mothers was minimal in most instances and amounted

experience of women during pregnancy. Since this in- to nomorethan 3.1 percent for any single item. formation was collected from the medical sources for Table ,VII shows the percent not ascertained for each mother, nonresponse rates from physicians and specific socioeconomic items by age ofmother andby medical facilities may have a significant impact on the live-birth order. In order to reduce the effect ofsuch completeness of coverage of the survey. The extent incomplete reporting on survey estimates, statistic of undercoverage is dependent both on the magnitude derived from querying the mother were adjusted for of nonresponse and on the relative proportion of ex- incomplete reporting by imputing to those who did not aminations reported by a single source andthoae re- respond the characteristics of similar respondents. ported by two sources or more. For methodological The procedure used is described in greater detailin purposes it may be assumed that if a responseis another report in this series.’t received from any of the sources questioned, all rele- Virtually all items on the questionnaire sent to vant examinations will, in fact, be reported. Thus for medical sources were satisfactorily completed. The examinations reported only byonesource ,theestimated few cases for which information was missing were

mainly imputed by consulting a staff radiologist.

Table V. Relative standard errors of medical X-ray visit rates, by size of base for rate

Table VI. Unadjusted and adjusted estimates of X-ray

Relative standardbase

error in percent X-ray examinations received during pregnancyfor of—visit

rate per 100

women

5 1o-------15-------

100,000 women

46.0 33.0 27.0

250,000 women

26.0 18.0 15.0

500,000 women

16.0 11.3

1,000,000 women

13.0 9.0

Class of examination

Number of

exami -nations reported

survey in

Adjust-ment factor for

response non-

Adjusted numb e r

of exami -

nations

20------- 23.0 13.0 ::: ;:; 25-------30-------

20.5 19.0

11.6 10.6 :::

5.8 Total 1,370 . . . 1,407 ---.--- 17.6 9.8 6.1 ::;

:L------ 16.5 9.2 5.7 4.6 Reported by 1 45------- 15.5 8.6 5.4 4.3 physician 263 100/93.1 282 50------- 14.7 8.2 4.1 Reported by 1 60------- 13.4 ::; 3.7 hospital 732 100/97.6 750

I

12.4 ;:2 4.3 3.5 Reported by 2 %------ 11.6 6.5 4.0 3.2 sources 297 . . . 297 90------- 11.0 6.1 3.8 3.1 Reported by 3 1oo------ 10.4 5.8 3.6 2.9 or more sources- 78 . . . 78

26

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Table VII. Percent of respondentsfor whom specifieditems were not ascertained,by age of mother and live-birthorder: 1963 National Natality Survey

I

Total Mother’s FatherrsAge of mother and number of Family Education Education

live-birth order respondents income of mother of father employment employment

status status

Total 3,218

Age of mother

Under 20 years 37320-24 years 1,07425-29 years30-34 years

t 35 years and over

Live-birthorder

FirstSecond-----------------------ThirdFourthFifth birth and over---------

948486337

864777595409573

Percent not ascertained

3.1 0.2 0.8 0.1 0.7

6.2 :.; 3.0 0.; . M 1.8 0.3 3.3 M ?:: 1.4 3.9 0.3 1.2 0.3

4.2 0.2 0.6 2.1 0.4 0.4

0.; 1.3 1.0 ;:? 0.5 1.0 0.7 4.5 0.9 1.4 0.; 1.0

27

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APPENDIX II

DEFINITIONS OF CERTAIN TERMS USED IN THIS REPORT

Age of mother.—Age of mother is recorded or derived from entries on the birth certificate.

Colov. —Color is recorded or derived from entries on the birth certificate for color or race as white or nonwhite. Nonwhite includes persons classified as Negro, American Indian, Chinese, Japanese, Aleut, Eskimo, Hawaiian, or part-Hawaiian. The category white includes all other persons. Persons stated td be Mexican or Puerto Rican are included with white.

Fetal loss. —This term is used synonymously with fetal death. A fetal death is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy. The death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Variation in the registration requirements in regard to completed weeks of gestation has an important bearing on this definition. Many States require the registration of fetal deaths of 20 or more completed weeks of gestation, while some require the registration of all products of conception irrespective of the duration of pregnancy.

Live-bivth ovder. —Live-birth order is derived from entries on the birth certificate and refers to the number of children born alive to the mother, including the” sample child.

Le@”timacy status. —For States reporting legitimacy data on the birth record, legitimacy status of a birth is recorded from entries on the birth certificate; for States not reporting legitimacy on the birth record, it is inferred from other evidence on the birth certif icate. The following 16 States did not report legitimacy statistics on the birth record in 1963: Arizona, Arkansas, California, Colorado, Connecticut, Georgia, Idaho, Maryland, Massachusetts, Montana, Nebraska, New Hampshire, New Mexico, New York, Oklahoma, and Vermont.

Family income. —Family income refers to the total of all income received during the preceding year by all persons related to each other by blood, marriage, or adoption and living in the same house-hold when the baby was born. Income from all sources is included, such as wages, salaries, unemployment compensation, and help from relatives,

Metropolitan status. —Usual residence of mother was classified by location inside or outside counties falling in standard metropolitan statistical areas (metropolitan State economic areas in New England) as delineated by the Office of Statistical Standards, U.S. Bureau of the Budget, for the 1960 census. 5 Although metropolitan status does not correspond exactly to the conventional urban-rural differentiation, it maybe useful in classifying the population into those living in or near metropolitan areas and those living elsewhere,

Region. —State of usual residence of mothers is classified according to four regions which correspond to the regions used by the U.S. Bureau of the Census. These are comprised as follows:

Re@”on States Included

Northeast Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

North Central Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin

South Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia

West Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

Medical X-ray visit. —A medical X-ray visit is defined as a visit to a physician’s office, hospital, mobile X-ray unit, Public Health Department, and so forth, during the course of which X-ray equipment is used for diagnosis or treatment. X-ray includes X-ray film photography and X-ray emission for treatment and fluoroscope but excludes the use of radioisotopes. Only one visit is counted for any single day, regardless of the number of X-ray examinations made. Medical X-ray visits exclude dental examinations taken for the primary

28

1

purpose of studying the condition or formation of the teeth.

Medical X-ray examination.-A medical X-ray examination is defined as the use of X-ray or fluoroscopic procedures to determine the presence, absence, or state of a disease or condition. For the purposes of this report, examinations also include the use of X-rays for treatment of a condition which has already been diagnosed. An X-ray visit may include several X-ray examinations.

Radioqaphic examination. —A radiographic examination is one in which the X-ray beam is passed through the patient’s body and is recorded on X-ray film.

Photojluoro~aphic examination. —A photo fluoro -graphic examination (usually of the chest) is one in which the X-ray beam is passed through the patient’s Imdy and excites a fluorescing screen, which is then photographed by a miniature format camera using photographic film.

Type of examination.— For the purposes of this report, examinations were classified into major groups, based primarily on the part of the body toward which the X-rays were directed. Examinations of the uterus and pelvic region related to pregnancy include pri

marily X-ray pelvimetry (measurement of fetal size and pelvic proportions), fetography (direct examination of the fetus), placentography (examination of the placental structure), and a small number of other examinations of the pelvic area. In the tables showing this data, this category has been subdivided into two subcategories: (a) pelvimetry, and (b) other examinations of the abdomen related to pregnancy.

Type of facility. —Type of facility is a classification of the types of places at which an X-ray visit or examination took place. The definitions of the two categories are as follows:

1. Physicians office is defied as the office of any doctor who has his own X-ray equipmen~ these may be subdivided according to the medical speciality of the physician’s practice.

2. Other places is defined as including hospitals (both inpatient and outpatient services) as well as other places at which X-ray services are provided, including private clinics, schools, mobile units, Public Health Departments, and so forth.

—

29

APPENDIX Ill

SOURCE FORMS

Standard Certificate of Live Birth

Form .mrowdBud,., B . . . . . No, 68-R87L2,

. . ..- CERTIFICATE OF LIVE BIRTM . . . . . ,.,k”r m,.,” ~0,

PLACE or 81*TH ,2. L$g:A+cRcslDmcE or MOTHER fv:’JN~ mother{i,,?] 0. cOuNTv

O. CITY. TOWN, OR I.CCATION C, CITY. ToWN. OR LCWATION

c, NAMEOF (If ml in hdrp{fol, #&e :trecf addre”) d. STREET ADDRESS HOSPITALOR !Nsr ,>1!0”

d. IS PLACEOF BIRTH INSIDE CITY LIMITS? ?, IS RESIDENCEINSIDE CITY LIMITS? f. !S RESIDENCEON A FARM?

Yfscl Nun YESD NOD YES � ~n

3, Maw Pir*t Middle L-lM

) ;Jlltil or

i 4. SEX h THIS BIRTH 5b. IF TWIN OR TRIPLET, WAS CHILD EORN 6, DATE dfmfh Day Ymr

SINGLE � ‘IWIN � TRIPLET � 1ST � 20 � 30 !J BI%H

7, NAME Fir$t Mfddlt .Lad 8, COLOROR RACE

,

i 9. hGE (At time oflhk birth) 10. BIRTHPUCE (.%ie or forekm counm) 11.. uSUALOCCUPATION 1lb, KIND OF BUSINESSOR INDUSTRY

VEARS

I.

~ 12. MAIDEN NAME Fird Middl, Lw[ 13, COLOROR RACE J

; 14, AGE (At lfm of fhia birth) 15. BIRTHPLACE(S1alt or r.reion C07@rV) !6. PREVIOUSDELIVERIESTO MoTHER (Do NOT include /h& bi,lh)

YEARS . . M“m nun, b, HQW m“. OTHh’R Wt. c, lie. ma .“ !c,.11 d.alk, OTHER cAil&,m ::” *Td*, *W,, Elk b., m. (Wnna tin dmd at A .Vi’

I?IFORWAMT .- .W ri.i.cf dim .!tcr . ..utii.m) T

6, MoTHEI?$ MAILING AOCIRE35

18! slaPIATunc k%. A’17ENDANTAT BIRTH 1 Ae,cbv L7rlfl, that thb child M, D. � D. 0. � MIDWIFE � OTHER (St)ccifr) 80., y~ ~lg on I&, ADDRESS 18.4 DATE SIGNED dated tie.

3. DATE RECD. BY LCCAL REG. 30, REGISTRARS SIGNATURE 21, DATEON WHICH GIVEN NAME ADDED

BY (R<vi,/r,v)

FOR � EDICAL Al10 HEALTH U$C O“LV (Th& #wire MLWT k filled out)

Z@, LENGTH OF PREGNANCY 23b, WEIGHT ATBIRTH 33, LEGITIMATE COMPLETED

LB. OL YES I-J No �WEEKS

(SPACEFOR ADDITION OF MEDICALANO HEALTH ITEMS BY INDIVIDUAL STAT33)

30

Survey Questionnaire for Mothers

,F’ R DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

(.. ) PUBLIC HEALTH SERVICE WASHINGTON q, D. C.

@ u..

.,

r

L

The U. S. PublicHealthSerntceis doinga nationalstudyto find out howmuch and what kinds of medicaland dentalcarewomen axe receitingduringthe year beforethe birth of a child. Nothingis knownaboutthe extentof the carereceivedby expectantmothers,even thoughsuch care is of thegreatestimportancefor the futurehealthof both motherand baby. Akaowledgeof what is actuallyhappeningthroughoutthe Nationwill go alongway in helpingto improvethe healthof mothersand babies.

The informationneededfor this studywill be based on the experienceof the mothersof 4,(XXIbabiesout of the 4 millionborn during1963. These motherswere selectedas a rsmlomsampleof all motherswho have a baby, antiyou axe one of thoseso selected. We axe thereforeaskingyou to answer the questionson the followingpagesof this form,and to returnit to us in the enclosesenvelopewhichrequiresno postage.

Pleasenoticethat$n the firstpart of the form the questionsask aboutdentzist,every.ioctor, hospital,or clinicfromwhichyou receives~ care

duringthe entireyearbeforeyourbaby was born. Your answersshouldnot be justfor~c=—connecteflw ith pregmancy,but for any EUV3all medical antidentalcare or che@supsduringtheseE’ months.

All.informationaboutyou and your baby willbe kept completelyconfidential.Your auswerswillbe used for healthresearchonly and for no otherpurpose.As you might expect,it Is particularlyimportantthatwe receiveyouranswersema thoseof all the other4,000mothers,sinceeach of you reallyrepresents1,(X3Omothers.

Your cooperationin this studyis deeplyappreciated.

Sincerely yours,

O. K. Sagen,1%. D., ChiefNationalVital Statistic.aDivisionNationalCenterfor’HealthStatistics

Name of Child

Date of Birth File Number I M

31

i

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COIIFIDEMTIALITY has b.. n � smvr. d the In.dlv idual ma published i. the F*daral Register lfmY 20. 1959

FORM APPROVEDBUDOET BUEEAU NO 68-8823

SURVEY OF MEDICAL AND DENTAL CARE

PART I. SOURCESOF AEDICAL AND DENTAL CARE DURING ONE-EAR PERl~DBEFQRE cHlLDBlRTH..——. -- ...-.. —-.. .—

.. Please provide the information requested 3. were you seen by a dentist during this bsluw about the physician, chiropractor or ore-year pericd? midwife who attended you at the recent birth of your child. � YES (_J# (Go on t.Question 4)o

Name 1

Complete a section below

Address for each dentist.

mm City (town) and State

Address Bow many time. were YOU seen by this

doctor during the one-year period? I City(t-) md Stat.

!.Were you seen by any other physicianor chiropractor during the one-year U.. many time. were you seen by this

psriod bafora the recent birth of dentist dwring the one-year p=riod?

your child?

� YES � MO (Go cm t. Question 3) Name

1 Address

Complete a section below for II

each doctor or chiropractor.City(town)and State

,%Ma

now m.my time= we=. You seen by this

dentist during the one-year period?Addre..

I4. During this one-year period, were you treated

and StateCity(town) or examined in a clinic or hospital notreported above? (In. Iude health checkups at

Row many times were you see. by this work, visit= to mobile health units, etc. )

doctor during the one-year period?

� YEs alto (G. on to next page)

Name 1

Complete a section below for each&bire8a

place where you were treated or exmnined.

II

Ci ty”(tom)and State

How many time. were yo” a..” by this

doctor during the one-year period?

Name 1+

Address N-

III

City (townj and Stat. Address “

II

‘d Stat.flowmany timeswere You seen by this City (tcm)doctor during the one-year period?

PLEASE GO ONTO PART 11~

32

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--------------

PART Il. RELATED INFOtiATION

L. Were ym eaployed outside yaw ha at any time 4. Was your husband eaplo~d at the time of your

during ycur recent pregnancy? child’s birth?

� FMLL-TIHE? OY ES (An...r a ..d Do (GO on to DYES - Was he working

b blow) “Qu..tion 2.)

� ao

fcheck one> { � PART-TfIIET

a. Did YDU work full-time at all duringyour recent pregnancy?

�YES Dno 5. Hhat”kind of work was your husband doing at the

time of your child!s birth?

1 lkhendid you atDP taxklng full-time?

~

b. Did you work part-tfmm at all duringycur recent pregnancy?

QY!?S on o

1

MIM did you stop working part-time?

(If he wa. not

~rkinf :hen, plea.e iim information for his Ia. t jpbj

GIVS FuLL DSSCS2PYIM (For example: erocery

cierk, �itto mmchanic, elementary .choal te.cher)

6. What waa the total inccma of your family during Mm th I D.y I Year. 1962? (Include �ll income such aa wages. caIariea,

19—

2. that was the highest grada (or year) of regular school that you ever attended? (Circle hiihe. t trade �ttended)

ROBE----------------- O

ELEHEIIYARY SCHOOL---- 12$S8678

II18H SCHOOL---------- 1 2 > 4

COLLEGE 1 z s 4 s 6+

Did you COMPLETE this grade? DYEs Oilo

3. E&hatwas the h.ichestmade (or yaar) of remlar school that ycu; huab&d ever a~tended? -(Circle hi~hest #rd. �tte.d.d>

uO#E O

ELI!HEIITARY tlCHOOL---- 12 Y456Y. S

H I @N SCIIOOL----------- 1 2 Y 4

COLLECT 1 2 5 Z 5 6+

Did he COHPLEIZ this grade? f_JYEs � no

[s-442s-19 (p.,. ,) -s1

rm..ploymen t tic.apenm tion, help from relatives,

. tc. , received by �ll members of the family Iivind

with you when your baby was born)

� solic

� USOER S1.000

� s1,000 - $1.999

� $z, ooo -$2.999

~s, ooo -53,999

0s4.000 -44.999

� s5.000 -$6.999

� s7.000 -$9.999

� s10.000- sl&999

� s1s.000 OR OVER

7, Whera did you live when ymr baby was born?(Please tiv. your home #ddre..)

Nuaber a“d Street

City (tin) md State —

, county

Is this place on a city lot (or in an apertmant building)?

OYES ~0

?Name and address of person ..mpietiq this form)

PIEMSEIBE FAC!ICPAGEIOR COMMENTS

33

Survey Questionnaire for Physicians

@%.,,~’~

%* DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE . ;~ * %. @ .,44.$ PUBLIC HEALTH SERVICE WASHINGTON 25, D. C.

%.’(it5JUSA

r

L

Your assistance is needed in a small but important sample survey conducted by the U. S. Public Health Serv5ce with the approval of your State Health Department. The prisnwy purpose of this surwy is to estimate how often mothers are exposed to ionizing radiation in the year preceding a birth. The survey will also provide useful data on the extent to which expectant n@hers avail themselves of medical care. The mothers on whom fk?ita-being collected were iiientlfiedfrom a random sample of about 4,000 births out of the 4 million occurring in the United States during 1963.

According to our records, the mother namea below was seen or treated by you at some time during the yesx prior to the recent birth of her child. We ask your cooperation in answering the questions on the following pages, which relate to the medical care she received during the one-year period preceding childbirth. The exact dates coveredby this period are shown below. Information is needed on each e~osure to ionizing radiation this womsm experienced during this period, irrespective of its relationship to pregnancy.

Since the survey is based on only a small sample of mothers, it is particularly important that we obtain .t%llinformation on each. A postage-free envelope is enclosed for your convenience in replying. You may be assured that your report willbe held in strictest confidence andueed only for statisticalresearch.

Your cooperation in this study is deeply appreciated.

Sincerely yours, fl

O.K. E@gen, PI@., Chief National Vital Statistics Division National Center for Health Statistics

P

Name of Mother Maiden Name

Address Place of Birth of Child

City-State Date of Birth File Number

IPERIODCOVEREDBYT”ISSURVEY: FROM TO I

34

CONFIDENTIALITY has be. n � ssu red ths Individual � s published In tha Fadaral R*gist*r )lay 20, 1959

ronu AFPEOVED. BUDOST BUREAU NO. 68-R82s

SURVEY OF RADIOLOGICAL EXAMINATIONS

PART I. Radiological EXAMINATIONS OR TREATMENTS OURINGONE-YEAR PERIODBEFORE CHlLDBlR~

To your knowledge, was the mother examined or treated by X-ray or fluoroscope at any time during€the one-year pericd bsfore childbirth as spscified at the bottcm of the preceding page?€

� 110 (Skip toP.srtIIcmlastps@)

DYES - How many radiologicalexaminationsor treatments. did ahe receiveduringthis one-yearparicd?

- (Complete section(s) below, then go on to last page)

> Complete a separate section below for EACH radiological examination or treatment performed riuring the ONE-YEAR PERIOD, whether or not related to pregnancy.

~ If the.S4ME TYPE of procedure was performed UORE THAN ONCE, please report E4CHSEPARATSLY.

� If more than ... procedure was performed on the SANE DATE, please report ii4CHSEPARATELY.

~ In reporting NUHBER OF EXPOSURES, please include those which may have been technically

unsatisfactory.

� If necessary, continue on a separate sheet.

SECTION1. FIRSTRADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD

1. Type of radiological€/ equipment used?

(check one)

Date of (aminaticm treatment?

2. Primary arsa of€bcdy exposed?€

3. Typs of service€rendered to mother?

menth) (check one)

{

(day) 4. Number of sxposures?

5. Place whera(year)

‘;”€

~ DDIAGHOSTIC uAoiocRApny � OIAGHOsTIC FLU OROSCOPY

: 00 IAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY

: a PELVIHETRY a I HTRAVEIIOUS PYELOGRAtl

: � PLACEIITOGRAPHY � OTIIER (specify)

~ iJROUTINE CHEST

j ~number) (includethosetech”ica:ly wsatisfactory)

Name of physician. hospi taI or clinic

1 ‘O;”-€

35

SECTION 2. SECOND RADIOLOGICAL EXAMINATION OR TREATMENT DURING ONE-YEAR PERIOD

( 1.Type of radiological ; O DIAGNOSTIC RAOIOGRAPH~ � DIAGflOSTIC FLUOROSCOPE

equipment used? ; � DIAGNOSTIC PHoTOFLUOROGRAPHY ~ X-RAY THERAPY

(check one)

Date ofexamination

2. Primary area ofr treatment?

bcdy exposed?

3, Type of service : � PELVI HETRy u ISTRAVESOUS PYELoGRAM

(month) rendered to mother?

; lJPLAcEIITOGRAPHY � OTHER (specify)(check one)

: � ROUTIHE cHcs7

(day) 4. Number of exposures? ~ (include those technically u“satisf.ctory) (number)

5. Place where(year)

Nmne of physician, hospital or clinic

““ I ‘Di’T-

SECTION 3. THIRD RADIOLOGICAL EXAMINATION OR TREATMENT DURING ONE-YEAR PERIOD

1, Type of radiological ; � 01AGHOSTIC RADIOGRAPHY � OIAGHOSTIC FLUOROSCOPE

equipment used? ! � OIAGSOSTIC PHOTO FLUOROGRAPHY O X-RAY THERAPY

(check one)

Date of

examination

r trsatment? 2. Primary arsa of

bcdy exposed?

3, Type of service ~ lJPELv I14ETRy UIIITRAVEN0u5 PYELOGRM4


; � PLACESTOGRApHY � OTHER (specify)(check one)

: � ROUTINE CHEST

(dey) 4. Number of exposures? ~ (include those technically unsatisfactory) (number)

(year) 5. Place whers ; � DONE AT MY OWN OFFICE

examination or OR Nameof physician. hospital or clinic

treatment wss

performed? sAddress

\ Ci ty.State

SECTION 4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT OURING ONE-YEAR PERIOD

1, Type Of radiO@i~l ~ � DIAGNOSTIC RADIOGRAPHY � oIAGSDSTIC FLUOROSCOPE

equipment used? I D oIAGIIOSTIC PHOTO FLUOROGRAPIIY O X-RAY THERAPY

(check one)

Date of :“

examination 2. Primary area of

r treatment?bcdy exposed?

3. Typs of service : IJ PELv IHETRY I_JIIITRAVEIIOUS PyELOGRAH

rendered to mother? (month) (check c.”e)

: � PLAcEsTOGRAPIIY � OTHER (specify)

: aROUTISE CHEST

{

(day) Q. Number of sxposures? ~ (include those technically unsatisfactory) (number)

(year) 5. Place where ; DOOME AT MY OWN OFFICE

examination or OR Name of physician, hospi t.1 or clinic

treatment was

performed? sAddress

\ City. St.9te

PART II. MEDICAL CARE RECEIVED BY MOTHER DURINGONE-YEAR PERIOOBEFORE CHlLDBlRTH

1. How many times did you see this patientduringthe 5. If you referredthis patientto anotherphysician, one-yearpericd? (If exact number not know”. or to a hospitalor clinic,please give names and pleasegivekst estimate) addrsssesof physiciansor institutionsto which

r4ferred. Number of times

2. On what date did you see her for the firsttire+?duringthe one-yearperioi?

Honth ‘iDay, year

3. On what date did you see her for the last timeduringthe one-yearperiod?

Month Day , ~ya

19

4. If this patientwas referrsdto you, pleasegivenames and addressesof referringphysicians,clinicsor hospitals.

Name

Address

City -.State

Nmne

Address

City-State

~

~

6. If this patientwas seen or treatedduringthe one-yearpsricd & any other physician,hospital or clinicnot reportedabove or on the previous pags, pleasegive names.ardaddresses.

~

Name

Address

City-State

<Nameofperscxi campletind this form)

37

Survey Questionnaire for Medical Facilities

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE WASHINGTON %5, D. C.

L

Your assistanceis neededin a smallbut importentsamplesurveyconductedby the U. S. PublicHealthservicewith the approvalof your StateHealthDepartment.The primarypurposeof this surveyis to estimatehow oftenmothersare exposedto ionizingradiationin the yearprecedinga birth.

useful.The surveywill alsoproyid.e data on the extentto whichexpectantmothersavailthemaelvesof medicalcare. The motherson whom dataarebeing collectedwere identifiedfroma randomsampleof about4,000birthsout of the 4 millionoccurringin the UnitedStatesduring1963.

belowwas seenor treateiiAccording to our records, themothernmneti atyour institutionat sometimeduringthe year priorto the recentbirthofher chila. We ask your cooperationIn answeringthe questtonson thefollowingpages,whichrelateto the medicalcare she receivmiciuringtheone-yeexperioilprecedingchildbirth.The exactdatescovereaby thisperioiiare shownbelow. Infomsationis neeaedon eachexposureto ionizingradiationthiswomanexperiencesduringthisperioa,irrespectiveof itsrelationshipto pregnancy.

Sincethe surveyis baseaon onlya smallsampleof mothers,it is particularlyimportantthatwe obtainfullinformationon each. A postage-freeenvelopeis enclosesfor your conveniencein replying. You may be assuredthatyour reportwill be heltlin strictestconfidenceand useilonly forstatisticalresearch.

Your cooperationin this studyis deeplyappreciated.

Sincerelyyours,

0. K%5*NationalVitalStatisticsDivisionNationalCenterfor HealthStatistics

Name of Mother Maiden Name

Address Place of Birth of Child

City-State Date of Birth File Number

PERIOO COVEREO BY THIS SURVEY: FROM To

38

I

COW FIDEWTIALITY has boon �ssu red tho individual � s publ l-hod in the Fed*rsl Rogi8t6r Hay 20. 1959

mnu 4PPmlv#D. SUDGST BEI;SAU MO. e,.aa,,

SURVEY OF RADIOLOGICAL EXAMINATIONS

PARTI. RADIOLOGICAL EXNINATIONS OR TREATMENTS DURINGONE-YEAR PERIODBEFORE CHlLDBlRTH

To your knowledge, was the mother examined or treated by X-ray or fluoroscope at any time duringthe one-year pericd before childbirth as spscified at the bottom of the preceding pags?

� IIO (Skip to Part IIon I.stpsge)

DYES + Howmany radiologiml e~minations ortreatmnts. did she receive during this one-year period?

(Complete section(s) below, then go on to last page)(number>

� Completes sepsrate section below for EACff radiological examination or treatment performed duri”g the ONE-YEAR PERIOD, whether or not related to pregnancy.

� If the SAME TYPE of procedure was performed MORE THAN ONCE, please report EACllSEPARATELY.

F If more than one procedure was performed on the SAME DATE, please report EACH SEPARATELY.

� In reporting NUHBER OF EXPOSURES, please include those which may have been technicality unsatisfactory.

� If necessary, continue on a separate sheet.

SECTION1. FIRSTRADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD

1. Type of radiological : � DIAGIIOSTIC RAOIOGRAPIIY � 01 A6110sTIc FLUOROSCOPE

equipment used? : � DIAGfiOSTIC PHOTOFLUOROGRAPHY � X-RAY THERAPY

(check one)

Date of:xamination 2. Primary area of. treatment?

bcdy exposed?

3. Type of service : � PELVIHETRY DINTRAVEMOUS PYELOGRAH


! � IPLACEIiTOGRJPHY l_JOTHER (.pecify)(check one)

j DROUTIHE CHEST

(<lay) U. Nurrkw of exposures? ; (inc~de tho.e technically unsatisfactory) (number)

(year) 5. Place where

Name of physician, hospital or clinic

‘“ Ino’i’’l===

SECTION2. SECONORAOIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD

1. Type of radiological ~ � Diagnostic RADIOGRhpny l_JcIl A6n0sTlc FLuORoscopY

/ equipment used? : � DIAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY

(check one)

Date of

examination 2. Primary area ofr treatment? bcdy exposed?

3. Type of service 1 lJPELVI HETRy I_JIH7RAvEH0us pycLocRAH

rendered to mother? ; 13 PLACEIIT0GRAPHY l_JOTHER {specify)

(month) (check one)

: � ROuTliiE cHEsT

((lay) 4. Number of exposures? : (includethose technically unsatisfactory) (number)

(year) 5. Place whet-s


““a’ in’;iATF===

SECTION3. THIRORADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD

1. Type of radiological ; � DIAGNOSTIC RADIOGRAPHY � DlA6M0sTflc FLuoROscOPY

/ equipment used? ; � LIIAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY

(check one)

Date of

exami nat ion 2. Primary area of r treatment? body exposed?

3, Type of service : l_JPELvlnETRy DIN TRAvCHOus PyELOcRAm


: � lpLACEt ITOGitApHY l_JoTHcR (sp.cify)(check one)

; lJROUTIIIE CHEST

(day) 4. Number of exposures? : (include those technically unsatisfactory) (“wnl>er)

(year) 5. Place where


‘%’” l“o;AT-

SECTION4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD

1. Type of radiological : � DIAGtIOSTIC RADIOGRAPHY � OIAGHOsTIC FLUOROSCOPE

equipment used? I DIAGNOSTIC PHOTOFLUOROGRAPHY IJX-RAY THERAPY

(check one)

Date of

examination 2. Primary area of

F treatment? body exposed?

3. Type of service : � pELv IHETRy � NT RAVEHOUS pYELOGRAM

rendered to mother? ; � pLAcEH70GRApHY � OTHER (specify)

(month) (check one)

! � 170uTl NE cHEs7

(

((lay) 4. Number of exposures? ; <incI.dethO.etechnicallyunsatisfactory) (“”ml>., )

—

(year) 5. Place where ~ � DONE AT THIS INSTITUTION

examination or OR Name of physician, hospital or clinic treatment was

%performed? Add, . s .

\ City.. State

I

PART Il. MEDICAL CARE RECEIVED BY MOTHER DURING ONE-YEAR PERIOD BEFORE CHILDBIRTH

1.. How many times was the patientseen at your 5, ~f you institutionreferzwdthis patientto institutionduringthe one-yearperiod? anotherhospitalor clinicor to a private (If exact number not known, pleas. give best estimte) physician,pleasegive names and addrassesof

physiciansor institutionsto which referred. Number of times

N.mmI

2. On what date was she seen for the firsttime Address

duringthe one-yearperiod? City-State

I J

Mm th I Day I Year

I 19

3. Gn what date was she seen for the last time duringthe ma-year period?

+. If this patientwas referredto your instituticm, pleasegive names and addressesof referring hospitals,clinicsor privatephysicians.

Name

Address

Cify. Staf=

Name

Address

city-stat=

b, If this patientwas seen or treatedduringthecme-yearperiodby any other hospital,clinicorphysiciannot reportedabove or on the previouspage, please give names and addrssses.

Name

City-.State

Name

Address

City-State

(Name of per.cm .-PI. t ing this form)

CowENTS

ooo —

41

OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS

Public Health Service Publication No. 1000

Seyies 1.

Sevies 2.

Sem”es 3.

Series 4.

SeYies 10.

Series 11.

Se2-ies 12.

PYograms and collection proceduves.— Rewrts which describe the general programs of the National Center for Health Staris~cs and its offices and divisions, data collection rneth~ds used, definitions, and other material necessary for understanding the data.

Data evaluation and methods YesearcJz. —Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, contributions to statistical theory.

AnuJyticaJ studies. —Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the exqmsitory types of reports in the other series.

Documents and committee YepoYts. —Final reports of major committees concerned with vital and health statistics, and documents such as recommended model vital registration laws and revised birtli and death certificates.

Data porn the Healtk InteYview Suvvey. —Statistics on illness, accidental injuries, disabili@, use of hospital, medical, dental, and other services, and other health-related topics, based on data collected in a continuing national household interview survey.

Data f%om the HeaJtk Examination Szmvey. - Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without reference to an esilicit finite universe of persons.

Data ji-om the Institutional Po&zLation Survey s.- Ststistics relating to the health characteristics of persons in institutions, and on medical, nursing, and personal care received, based on national samples of establishments providing these services and samples of the residents or patients.

SeYies 13.

Sen”es 20.

SeYies 21.

Series 22.

Data j?onz tke Hospital Discharce Survey. -Statistics relating to discharged patients in short-stay hospitals, based on a sample of patient records in a national ssmple of hospitals.

Data on mo~taMy.-Various statistics on mortality other than as included in annual or monthly reports— special analyses by cause of death, age, and other demographic variables, also geographic and time series analyses.

Data on natality, mayriage, anddivorce. —Various statistics on natality, marriage, and divorce other than as included in annual or monthly reports—special analyses by demographic variables, also geographic and time series analyses, studies of fertility.

Data jrom the National iVataMy and Mortality Survevs. —Statistics on characteristics of births and deaths not available from the vital records, b&ed on krnple surveys stemming from these records, including such topics as mortality by socioeconomic class, medical experience in the last year of life, characteristics of pregnancy, etc.

For a list of titles of reports published in these series, write to: Office of Information

National Center for Health Statistics U.S. Public Health Service Washington, D.C. 20201